What questions are asked of candidates in the President of Royal College of Physicians London election?

I was an unsuccessful  candidate in the 2018 President of Royal College of Physicians London election. 

GPFUQ #2018: What questions are asked of candidates in the President of Royal College of Physicians London election?

Candidates are asked for an election statement, a 5 minute video and to answer some set questions

My election statement included

Modern physicians come in all shapes and sizes, and work across the health services. Our challenge is that everywhere in the world health care systems are struggling to meet the 2008 triple aims of the Institute for Health improvement: providing the best care for patients, the best health for the population, and doing it all at lower costs. The gap between what we want to do and what we can do for our patients increases. In 2014 a vital extra aim, the quadruple, was suggested: to improve the work-life of the health care providers.

Our well-being is essential if we want to achieve the triple aim. Advocating ‘the beatings will continue until morale improves’ does not work.

Despite the UK’s NHS being underfunded, under doctored and overstretched, the Commonwealth Fund’s report ‘Mirror Mirror 2017’ comparing health care in eleven developed countries continues to rank the UK as the best health service. We remain among the worst for health care outcomes, but during the past decade we had the largest reduction in mortality amenable to health care.

To stay ahead and keep improving we must rethink the ways we work and tackle the many potholes, blind spots and diversions that slow our progress. Physicians and their teams need our college to provide them the support, knowledge and inspiration to achieve the best care possible for patients.

Why make me your top choice? Vote for me if you:

·      Want every physician to know what ‘good’ looks like, what stops us providing the best service, and how we can make real improvements happen.

·      Want the RCP to make itself more relevant to members and fellows and be less opaque.

·      Want any college complacencies challenged.

·      Prize wisdom, building great working teams, and collaboration.

·      Respect others points of view, and accept that compromise is the usual way forward.

·      Believe nothing is impossible as you long as do not need to do it all or take all the credit yourself.

·      Think modern medicine may founder because we do not show enough respect and kindness to others, and not due to insufficient science and technology.

·      Support an enthusiast who is experienced at making organisations improve their performance for their members.

The questions were requested by RCP from the candidates for President. Answers to each of the 5 sections was limited to 600 words. These are expanded answers and suggestions for action.

In general, 1. RCP will be a better college when it actively uses and is used by its 35,000 members & fellows throughout their careers. 2. Any change should be informed by asking and answering 5 questions that make improvement more likely. What are we trying to achieve? What do we know about this already? What are our success criteria? What can we actually do with the resources available? How and when will we review this improvement plan?

1 - PATIENT CARE

‘They may forget your name, but they will never forget how you made them feel’ Maya Angelou‘

1.How would you work to improve RCP support for primary care, to diminish the hospital/practice barriers in the Health Service?

The main barriers to overcome are poor communication and social intelligence. The most important infrastructure improvement is using a shared electronic patient health record that allows easy information sharing, and communication across boundaries. Barbara Starfield’s research showed that larger, stronger and more integrated primary care system have improved population health outcomes. Starfield’s 4Cs of Primary care are: First Contact access, Continuity, Comprehensiveness, and Care coordination. In contrast many studies show that primary care is inferior to secondary care for individual diseases and their disease specific outcomes. Getting the right mix of generalists and specialists and working together effectively is more important than ever for patients. The frontline for physicians is now outside the walls of the hospitals and in the community. That’s where the patients are and mostly where they and we want them to get most of their care. General practice is the high volume low cost gateway to higher cost and lower volume secondary care and to stop secondary care being overwhelmed we need good care in primary care to soak up most of the demand and manage most of the risk. We need more physicians working with and advising GPs to provide patients the very best care in the community where their care is changing fast. It is being delivered less by GPs themselves and its becoming a more GP and specialist led service.

We know there is broad consensus that the right way forward is to focus on more joined up care and avoid working in silos. We know that integrated care is more talked about than achieved. We know there are frustrating inefficiencies and if we can access some of this wasted funding we can do more of what’s good for patients and staff.

There are a variety of ways to reduce barriers with better communication and social intelligence. Suggestions include:

·       Recommend that as part of any high-quality revalidation every physician should spend one session in general practice every 5 years (and vice versa), and that for multisource feedback MSF every physician get feedback from at least one GP (and vice versa)

·       Work together locally to solve common problems - Snowmed CT will be rolled out in primary care in 2018 and in secondary care by 2020. This is an opportunity for collaborative work to ensure our diagnostic codlings are aligned and make sense.

·       Create better messaging about patient care via the shared electronic patient health record

·       Initiate buddy systems between locality leads from RCP and RCGP who filter and channel the important information to be shared with other physicians and GPs about better working practices that reduce barriers

·       Have more joint Hub (physician lead) and spoke (GP lead) clinics in primary care

·       Ensure all physicians trainees in core medical training and speciality training have experience in primary care with emphasis on understanding that health care is a continuum with interdependence rather than rivalry between branches of medicine

·       Engage with hospitals & GPs so they have a simple process for feedback e.g. SMS text messaging, or email process to inform them of breaches of best conduct

·       Plan an in-reach service regarding the care of patients in hospital. In many countries GPs visit patients in hospital; this is popular with patients and GPs can assist with optimising discharge planning and subsequent care/

·       Stop seeing people after hospital outpatients to give them results. The consultant should send a copy of the letter / result directly to the patient unless there is an overwhelming reason not to.

·       Have a robust system for giving and taking messages between GP surgeries and Hospital based doctors about patients.

·       Agree a process with hospital about OP and discharge letters - it’s important to write back to the doctor who wrote the letter

·       Set up a local pairing consultant/GP scheme. Improve collaborative working with hospital consultants to provide greater collaborative working among GP and consultants, including troubleshooting and communicating each others knowledge, skills, understanding and attitudes which may allow faster dissemination of better practices for joint working and patient care – a pairing/buddy system between a GP and a consultant. A GP works with one local consultant to help him/her provide the important information for GPs and patients and robust contact details.

·       Have a local triage service for GP referrals before they get to secondary care. This ensures roughly uniform criteria for referral, educates individual GPs, identifies general referral problems that may be managed better by hospital physicians, and limits unnecessary referrals to secondary care

2. With the increasing number of older patients with multiple comorbidities presenting to our hospitals what will you do to ensure that all physicians are equipped to treat them?

This is the role of their GP. It’s not possible for one physician to have the knowledge and skills to manage the breadth and depth of a patient’s comorbidities. Each physician can add value to their patients care with their specialist knowledge, can access the expertise of others and inform the patient, treating physician, and GP of the options for care. We urgently need shared electronic patient health records with all the benefits that will bring for managing patients, and their comorbidities inside and outside hospital more effectively and efficiently.

3.What aspects have you personally done to improve patient safety or patient care in the last 3 years and how will you encourage others to do the same if elected, given that the NHS is underfunded and under doctored?

Continuous quality Improvement for the benefit of patients and staff has been my priority for over 20 years. I promoted and led my practice in a variety of criterion-based quality awards including the RCGP Quality Practice Award 3 times prior to my retirement as a partner in my practice in December 2015. Each Quality Practice award lasted for 5 years and covered the period 2001-2018. Only 302 (of about 12,000) practices in the UK have achieved this award and only 4 have achieved it 3 times. Since 2015 I have done unpaid clinical sessions in general practice.

I have written an article in the BJGP in 2017 that promotes more shared decision making ‘NNTs and NNHs: essential for rational prescribing’

http://bjgp.org/content/67/656/132

I believe and encourage leading physicians to be part of a collaborative learning culture: where we are always asking and answering questions about what we do and why we do it, looking at current practice and keep making improvements: building better teams, coordinating better care across health and social care and across secondary and primary care, increasing better self-care of patients, providing better preventative health for the whole population and the targeted ‘at risk’ groups. The resulting culture and climate of constant improvement produces safer care and great places to work

4.Healthcare generally is under enormous pressure, clearly, the consequences of an ageing population, the rise of progressively dwindling conditions, and multiple morbidities are slowly overwhelming traditional approaches to primary and secondary care. What responsible leadership do you think the RCP could contribute apart from simply asking for more resource?

It is always going to improve care for our patients if primary and secondary care work better together. Patients should look to their GP for continuity, coordination and comprehensiveness in their care. Specialist physicians need to communicate effectively with GPs and patients about the options for the best care of specific conditions. GP and patient need to agree what’s best for the patient. Physicians, GPs and patients need to identify gaps in health provision then balance collaboration with speaking truth to power, and agitating for improvement in a professional and respectful way. We should avoid asking for extra money if we are already spending money doing something valueless, or if we are looking for technical solutions to existential problems.

5.The nature of our NHS is threatened as never before, not only by chronic underfunding but more importantly (in the long term) by increasing privatisation and marketization. This threat will not disappear overnight and will require persistent informed scholarship and argument. The public, unfortunately (despite enormous effort by campaigning groups throughout the country), remains to a large extent ill-informed and as a consequence apathetic to this grave situation. For the long-term future and security of our NHS and it's continuing evolution based on its founding principles (which are so much more than 'free at the point of delivery'), it will be necessary for medical students (and doctors generally), to be aware that just as they endeavour to act on behalf of each of their patient's best interests, so they need to be aware that to be in a position to continue to do this into the future, they need to understand the continuing threats to our NHS and be alert to each threat as and when it arises so as to maintain the integrity of our NHS as a  Public Service. I would wish to know your views and intentions regarding the position have I have briefly set out above 

Our campaign defending an NHS ‘under siege’ should switch to attacking to improve it. Like most doctors I strongly support the 1948 founding principles of the NHS and the 2011 update of its principles and values. If you grow up with the NHS you tend to take it for granted.  I only really understood what is special about the NHS when I travelled and worked outside the UK. The NHS remains far from perfect and it needs to be improved. I do want the government to be continuously improving the NHS and not weaken its effectiveness either on purpose or by accident. Although the RCP is not the Royal College of NHS Physicians it has a clear vision to have the best possible health and healthcare for everyone by influencing the way that healthcare is designed and delivered so it's the highest quality and the best value. The US Commonwealth Fund continues to rank the UK as the best health service. At its best the NHS is hard to beat as a health system for everyone but it is not good enough for 21^st Century.

6.Acute hospital services have rightly been the chief concern and focus of policy and action for the RCP. How would you balance concerns for acute services with the need to maintain high standards and acceptable waiting times in elective and outpatient medical services?

We must improve and support the capabilities and capacity of primary care to stop the increase in and reduce the demand on secondary care services so that elective and outpatient service can play their part improving efficient and effective health care. We want quick access to high quality, low cost health care. Acute services are one stop on the patient journey, and holdups along the line at elective and out patients’ services just add to the problems. With 90% of patient contacts happening in primary care we must reduce the shift from primary care to secondary care that is overwhelming secondary and hospital based care.

7.The RCP has a long history of being committed to patient involvement through its Patient & Carer Network. How will you build on this to ensure it can have the maximum impact on service improvement?

We will never work in the good organizations that exceed rather than just meet patient expectations unless we work with ppatients and carers as equal partners. Patients can feel like pinballs bouncing around a dysfunctional service. The Patient & Carer Network needs to be able to provide feedback and guidance on service improvements. Patients must have sufficient information or access to information for them to self manage. They need easy access to their medical notes and to know when and how to contact their GP and specialist. We need to make sure care is coordinated and /or integrated across all elements of the system and the patient’s community, and that a patient’s referral is tracked, results are tracked, the patient is informed of the results and knows there was an interaction between his/her doctors. The patients learn what to do next and somebody asks the patient if everything turned out OK. We should have an easy to use template and process that we can use to report any problems with quality. We need to increase clinical integration and avoid the pinball experience for patients.

We should get in the habit of always asking 'is there something else you want to address today.

We should not be afraid of feedback and comparing results and processes

2 – THE RCP

“It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change.” Charles Darwin

1.What will you do to ensure adequate representation of small specialties across the RCP, for example so that Council is not dominated by the large specialties?

All the smaller specialities must feel represented with a voice that is heard. It is difficult to get the balance of democracy exactly right. Like many specialities and despite its size General Practice is also under represented in RCP. RCP has various committees and an annual national meeting for specialty representatives and SAC chairs. Following my election and before starting in post in September I would undertake to gets the views of the smaller specialities about how they think their representation can be improved.  

2.How will you reach out to consultants doing busy work schedules and hence unable to attend meetings at the RCP?

I had a sabbatical that explored ‘how to find and spread best practice faster’. My conclusion was ‘find yourself a better network’. The RCP must be that better network.

Members and fellow should have easy access to the president, and other college officers, and expect quick and helpful responses from colleagues in the college. Other routes like social media including Facebook groups and Twitter can make access to college information and the officers easy.

We need good signposting and advertising of opportunities for members and fellows to connect and engage with the College and increase the opportunities for members to informally network and share their knowledge and expertise in more thriving local and regional networks.

All members and fellows should be able to choose the relevance, quality and frequency of our communications, both online and print to suit their needs.

I’m very happy to speak with and visit colleagues wherever they are.

3.What should the future relationships with Scottish Physicianly colleges be going forward?

RCP should have and promote a culture of collaboration and ‘keep building bridges’ but we must always have robust legally binding contractual agreements with other organisations. We need to make sure the bridges we do build are jointly resourced, have a fair return on investment, and are well constructed for the benefit of the RCP.

4.How would you seek to make the RCP more relevant to its General Practitioner members and fellows?

RCP need to develop and support a ‘general physician in general practice’ career pathway for them to follow that along the way includes recognising and awarding them FRCP for their contributions.

As a past president of RCGP I’m in a privileged position to know and understand better the wants and needs of UK general practice. Although GPs who achieved RCP membership have demonstrated their commitment to high standards of learning and performance, the RCP tends to exclude them from the mainstream of the college. GPs with MRCP are an under-valued and an under-used resource.

5.The RCP's International Office is expected to play a more active role towards meeting some of the ambitions of fellows currently practicing overseas. Do you agree to this? And if the answer is yes, what are your proposed plans to enhance this role?

RCP rightly aspires to be a global expert organisation. The RCP has 18% international members. This meets the definition of a ‘truly international’ but not yet a ‘global’ organisation (=50% international members). Because the world cannot be understood from a single point of view, we should always be seeking to support but also learn from the experience of international members and fellows, and increase collaborations like the current one with the American College of Physicians (ACP). RCP needs to review how it is organised to match it global aspirations. Studies of other international organisations suggest most will normally have several non-national chapter or representative bodies that deliver unique services or networking opportunities at a local / regional / national level outside the “home” territory. There may be at least 1 non-national representative on its Board, usually defined as an official representative of the non-national chapter(s) or affiliate(s). There will be a dedicated service or representation of non-national members with an allocated budget and at least part time support staff. The focus is primarily on international issues with adaptation at the national / regional level.

6.How would you increase the profile, relevance and impact on the RCP in the physicianly journey?

The RCP, its network and resources, needs to be a source of support, knowledge and inspiration relevant to each physician’s career journey. Most membership organisations now try to ensure their members enjoy and report a continuing positive experience of membership rather than just expect loyalty in return for a list of member benefits. We need to look at stretch goals for the improvement of the college, use measures of performance and get regular feedback from members to drive improvements in membership experience.  

7.What would be the single most important goal of your presidency and how, exactly, would you secure that?

The goal is to increase professional autonomy and for every physician to be able say to what ‘good’ looks like for them, to be able to speak out for themselves and their patients about what stops them providing that good service, and how they can keep making real improvements happen.

8.How will you ensure that RCP makes use of the enormous management expertise and experience gathered by senior fellows, to engage with local management to influence better care?

The biggest asset that the RCP possesses is the knowledge and skills of its 35,000 members and fellows.  We must recognise, track it and use our network’s asset of expertise, experience and evidence to engage with others and be the wisest voice on the important health issues.  We can have great influence improving the health care of our patients and be the leading college our members want and need.

3 - INFLUENCING HEALTH

Education is the most powerful weapon which you can use to change the world. Nelson Mandela

1.Why do you think the medical colleges and associations have relatively little influence and impact on the policy and funding of health care, and what during your tenure would you do to improve this?

We need to change from defending the existence of the NHS to attack and be aggressive about improving the NHS. Most politicians are not health experts or statesmen. Our duty is to educate them to guide their decisions towards genuine improvements rather than ill informed changes. The NHS is still one of the most valued assets in the UK, and no political party wants to be responsible for the collapse of the NHS. We need to join with other colleges, charities and research organisations to have effective media offices, work with MPs to raise questions in parliament, with members of the Health select committee, and target the party conferences to make the NHS an evidence based health system that is free from political party interference. Although medical colleges can have more influence than many other bodies, often the real problem is that government departments funding decisions are constrained by the Treasury. We go to the source to influence the Treasury by increasing public and media pressure to create a depoliticised and improving NHS.

2.How will you balance criticism of the government with keeping channels of communication open?

RCP should aim to be a critical friend using evidence and the wisdom of its members/fellows to influence and guide government for the benefit of patients. Walking the tight rope is difficult but we should give praise and support when Government does the right thing and withhold praise and support but keep silent when the government chooses to ignore our best advice. You can’t influence others if you don’t have their ear.

3.What steps will you take as President to interact with the governments of the 4 UK nations?

We have 4 different NHS in England and the devolved countries. We must support physicians who are our RCP representatives in the devolved countries to interact with their governments. The RCP can also interact via the Academies of Medical Royal Colleges in each country.

The politicians must always be seen to promise and NHS managers must always be seen to plan a better service. But without better promises and plans that follow the rules of continuous quality improvement, or great luck, a better service doesn’t result. RCP must help set the direction for improvement standards in each country.

4.Given the shortage of doctors, nurses and lack of money in the NHS, how will you convince the government to take urgent action?

The public and the media are our greatest allies to influence the government to take urgent actions. All the stakeholders need to agree ‘non-self-serving’ approaches and report to Government on the state of the NHS, comparing our expenditure and outcomes with similar developed countries.

5.How do you see the RCP's role in promoting sustainable healthcare practices to help protect the health of current and future generations in the UK and globally?

RCP should support schemes like the NUS Green Impact for Health https://sustainability.nus.org.uk/green-impact/articles/how-green-impact-works-in-healthcare that makes it easier for busy hospitals to become more sustainable. I was one of the founders and am the current chair of the Green Impact for Health in General Practice scheme. The problem for everyone is to make it easy to know what can be done when you ‘think global and want to act local’. RCP is a founding member of UK Health Alliance on Climate Change that is an advocate for responses to climate change that protect and promote public health.

6.How do you intend to hold industry and the government to account for their role in promoting and supporting ongoing lifestyle diseases?

RCP has influence but no power in these matters. All the usual forms of influence can be used as described elsewhere in these answers. All these efforts to influence come at a price but one suggestion is ‘name and shame’. RCP could publish an annual league table on ‘Lifestyle’ achievements with the reason for the high, middle or low ranking. 

7.How do you intend to maintain and improve the RCP's contributions to public health?

RCP must always have clear public health policies. Improving the health of the public by reducing the harms that they are exposed to or will be exposed to will always be important. No health care system will cope with the increasing burden of disease associated with the modern world. RCP should continue to use the best evidence and campaign with others for improvements. Current campaigns include air pollution and climate change, alcohol misuse, tackling obesity, tobacco control.  RCP needs to review if it can increase its influence or impact in these and any other ‘upstream’ causes of ill health.

8.Given the likelihood of continuing shortfalls in NHS budgets, what do you consider that the RCP should recommend that the NHS no longer fund?

 

The RCP has a vision, mission and values – none of which include stopping any funding for the good care of our patients. Physicians must improve the care our patients by being more efficient, and stopping inappropriate or unwanted investigations and treatments. The Montgomery V. Lanarkshire verdict has changed the nature of shared decision making in the UK. As this higher standard of discussion and decision making with patients about their treatment choices become more common the research evidence suggests patients may make more frugal and more efficient choices than those the health care system does for them. The treasury must take the responsibility for the under funding the nations health service. The public (and media) must take responsibility for influencing the government and its treasury.

9.Should Brexit drive us into deregulated commercial medicine will you then fight for proper standards in medical practice, even if this involved politics?

The RCP will always campaign for proper standards in medical practice and would take any stand necessary to promote the highest medical care possible for patients. Setting and campaigning for high standards in health care is above party politics.

4 - EDUCATION, TRAINING, AND PERSONAL DEVELOPMENT

Education is not the filling of a pail, but the lighting of a fire. William Butler Yeats

1.Do you think that the current plan for Shape of Training is too complex?

Regardless of its complexity Shape of Training does not appear to be a plan that will help fulfil the Quadruple aim for health care - providing the best care for patients, the best health for the population, doing it all at lower costs and improving the work-life of the health care providers. Examples of flaws include: 90% of patient encounters are in primary care and any sustainable plan for the health service must improve the knowledge and skills in primary care so that GPs provide the best care for their patients in the community and protect secondary care from being overwhelmed. Shape of training dismisses the longstanding RCGP call for 4-year GP training. Other flaws include the SoT plan for post CCT credentialing for physician sub-specialities which remains vague.

2.How would you emphasise the importance of undergraduate teaching in pathology as well as a continuum in the foundation years as a major contribution to future of medicine?

Many specialities feel they are underserved in undergraduate and foundation years. A career in medicine needs good careers mentoring, a support system to help physicians fulfil their potential, through lifelong learning. Clearly there needs to have a balanced workforce of specialists and generalist to service the needs of the population. In the six months between election and taking up office I would undertake to seek to find what needs to be done regarding pathology and other underserved specialities and what can be done.

3.How do you see the exam evolving at home and abroad over the next 4 years?

The exam has a worldwide reputation as a mark of quality. In an increasingly internationally aware world the new exam provider organisation needs to ensure the value and relevance of the exam continues to increase and that the exam becomes recognised as an international passport of attainment.

4.How do you intend to work with other colleges to enable transferable training between the various branches of medicine, and how within the RCP do you intend to address the same issue?

The GMC has general professional capabilities that all trainees will need to acquire. RCP should work with other colleges (in a business-like way) to commission and provide the range of transferable training. We should be working with other colleges to improve the quality and accessibility of our educational offerings including eLearning and CPD accredited courses and events for subspecialties.

5.How would you redress the plummeting morale of trainees in medicine?

The biggest problem to overcome in the NHS is that when things go wrong it leaves a legacy of unresolved anger and mistrust that is difficult to overcome. This used to just apply to patients but now it also applies to staff. We need to acknowledge and address the anger and mistrust and provide pastoral care, peer support groups, and learner sets, remove unnecessary bureaucracy and regulation then celebrate success to bring back the sparkle and joy in doing a great job.

6.We write curricula, describe standards and conduct high stakes exams. Should we be more involved with those responsible for the delivery of training that supports this?

There is a conflict of interest when the examining body is also the training body supporting the examinee to pass the exam. We should be involved with the trainers by giving high quality feedback on the process and outcomes of training so that training can continue to be improved.

7.How will you support fellows at consultant level to inculcate mentorship and supervision / pastoral care of trainees without the presence of traditional firms?

The RCP should detail a robust support system that includes guidance on what ‘good’ looks like regarding supervision, mentoring, protected time, team working, rota management, support systems etc. Many trainees feel they are not supported, not valued and don’t have control over their work life balance. Consultants do need to be the good role models for the consultants of the future, but good role models do not happen by accident.

8.The rather rigid training scheme for SpRs is inappropriate for clinical academic careers with, usually, only 1 year being spent in the teaching hospital. The RCP has not supported young academics terribly well in terms of leadership. How would you address this problem in association with the Academy of Medical Sciences?

Good academics with good leadership skills are essential for the future of high quality health care. I don’t have any special knowledge about he specifics of the problem or current approaches with the Academy of Medical Sciences. Following my election and before starting in post in September I would undertake to gets the views of academics about how they think RCP can support their training better.

5 - WORKING AS A PHYSICIAN

The good physician treats the disease; the great physician treats the patient who has the disease. William Osler

1.SAS doctors form a vital part of NHS work force. What have you done so far to engage with the SAS doctors locally and nationally and how will you ensure that the RCP has better engagement with the SAS doctors?

My career has been in general practice so I have not engaged with Staff and Associate Specialist and Speciality doctors. I want all physicians to have fulfilling careers where they can provide great care for their patients. In the six months between being elected and taking up the post of president I would expect to learn what SAS doctors need and want from RCP.

2.What recommendations would you make to the government to reduce the impact of ongoing and future staff shortages?

In the absence of the best solution – more trained staff – then we need to rethink what we do and how we do it. There is no easy solution. We must keep physicians doing what they want to do and what only they can do, that is working ‘at the top of their licence’ most of the time and delegate work collaboratively with our patients and the other health care professionals to manage the workload. Sharing the problem with patients and carers and reassuring them what we can and will do for them but asking them to help by reducing unnecessary demands. We need to use our network to find and share good solutions faster

Suggestions for action include

·       Stop working in isolation, without your work being observed

·       Have annual formative in-house annual performance management of physicians. Neither NHS appraisal nor GMC revalidation are effective or useful in performance management.

·       Have in-house performance measures that are important and relevant in your team. Choose measures that may be a problem and will make a difference for patient care

·       Train, value and have career progression for non-clinical roles as well as clinical roles.

·       Tell and thank your staff and colleagues when things are going well

·       Aim for communicating and coordinating care better for patients in the different settings (health, social care, community, home), with better self care of patients, targeted ‘at risk’ groups and better preventative health for the population

3.The NHS has a crisis with recruitment and retention of doctors. How do you propose to improve this?

There are many contributing causes to insufficient recruitment and retention, and each must be addressed. A confidential enquiry (as suggested in #5.5) could help identify the important problems. As regards recruitment we want to recruit competent and motivated doctors who will enjoy and be supported in challenging but fulfilling careers as physicians. There are three main problems – not enough British trained graduates, poor career guidance, and insufficient support for junior doctors. Each must be addressed 

Similarly, with retention each physician may have very different reasons for leaving but as part of each physician’s formative annual performance reviews we should aim to improve jobs and working conditions to meet the needs and wants of both individual and the employer, and plan changes like moving to part time work rather than retirement.

4.Which 3 key steps would you introduce, or lobby government to implement, in order to reduce burnout and increase physician retention?

Three key steps 1. Promise more resources (money, people and facilities) throughout the NHS to offer hope and reverse the current decline. 2. Reduce the over regulation and bureaucracy which reduces professional autonomy, control over day to day work and integrated working across boundaries. 3. Extend London’s Practitioner Health Programme and the NHS England’s GP Health Service to all doctors in the UK to help individual physicians and better understand the root causes of the burnout.

5.’How do you propose to deal with the mismatch between training numbers, the current excess of CCT holders in most of the physicianly specialties, and the large number of vacant Consultant posts?’

Possible ways to make progress include setting up a ‘confidential enquiry’ to detail the experience of the CCT holders and the trusts with unfilled posts. A perfect storm caused by multiple factors has creating the mismatch described. There are not enough doctors to service all the specialities needs, and there is a mismatch within specialities between generalists and sub-specialist. The system is currently not training enough physicians to meet NHS requirements.

6.What steps will you take to promote clinical research amongst members, Fellows and trainees?

The RCP aims to support physicians to fulfil their potential by delivering the highest quality and best value service, and by being forward looking and evidenced based. ‘Research and Scholarship.’ Is one of the GMC general professional capabilities for speciality trainees. Physicians will have different wants and needs in relation to research and scholarship at different stages of their careers. They will always need to be critical thinkers.   I have had various roles both doing research and promoting research. We want physicians to be able to contribute to high quality research but this is complicated and expensive to do well. Our biggest asset is our networks of researchers and mentors who can help others to do research well. In addition, we should expand our training courses, eLearning and collaborations on research skills.